UnitedHealth Post Hoc Analysis: Treat 1,250 People With Vytorin To Prevent One CV Event, When Compared To Atorvastatin?

Here’s a great comment, just now posted — about today’s UnitedHealth study presentation at AHA, in Orlando; it deserves “front-page” exposure:

. . . .Let’s do a little “Number-Needed-to-Treat” (NNT) and economic analysis, shall we?

From the Stockl presentation of these data at AHA, today:

Vytorin (simvastatin/ezetimibe) 96 events/9983 patients over 1.06 years of follow-up = 0.91%/year event rate

Atorvastatin 115 events/9983 patients over 1.16 years of follow-up = 0.99%/year event rate

Simva 124 events/9983 patients over 1.08 years of follow-up = 1.15%/year event rate

NNT = 1/absolute risk difference

Vytorin (simvastatin/ezetimibe) vs atorvastatin NNT = 1,250. This means you’d have to treat 1250 patients to prevent one event with Vytorin compared to atorvastatin.

Vytorin vs. simvastatin NNT =417

Assuming simvastatin costs 84 cents/day, atorvastatin $3.91/day, and Vytorin $3.74/day:

You’d have to spend $1.7 million to treat 1,250 patients for one year with Vytorin vs. atorvastatin to prevent one event, or spend $570 million for Vytorin vs. simvastatin, for one to prevent one event.

Since your average stroke/MI hospitalization costs about $30,000, we would have to spend way too much money to use Vytorin vs. either atorvastatin or dirt-cheap generic simvastatin. I’m no Peter Orszag, but I’m pretty sure there’s no way that will ever be viewed as cost-effective.

Don’t think we’ll be seeing any such analysis out of the Merck health outcomes shop any time soon.

– Anonymous, November 18, 2009 10:00 PM. . . .

~~~~~ Later ~~~~~

Now let’s get really re-dick-ulous! How about a pairing? . . .The UHC report with the known curvilinear relationship between LDL and events at the far low end of the LDL curve (think, IMPROVE-IT). Yes folks, the answer is the same. An LDL from 65 to 55 with a predicted 0.1% absolute risk difference in meaningful events (heart disease death, heart attack). That’s a NNT of. . . . 1000. Hmmm. . . there’s some symmetry there with the UHC findings. So, just go ahead boys and girls, keep those prescriptions coming. . . or, maybe with those odds, patients should save the money and play some powerball. There’s a better chance of meaningful return on investment, and it goes to a better cause. . . .

November 18, 2009 11:25 PM

Insurer-Sponsored Post Hoc 30,000 Patient Study: “Merck’s Vytorin Of No Incremental Benefit”

Yes, the sponsor of the study has a financial incentive to see patients take less pricey medicines (especially if the results don’t really differ, between outcomes from the pricey and the cheap drugs), and yes it was not peer-reviewed, or vetted, as a NEJM article would be, but it did examine 30,000 patients’ histories. That makes it twice the size of the much debated IMPROVE-IT trial, still stuck at 15,000 patients.

Peter Loftus, for the Wall Street Journal, reporting from the AHA, in Orlando:

. . . .A new study by health insurer UnitedHealth Group Inc. concludes Merck & Co.’s cholesterol drug Vytorin didn’t significantly reduce the risk of heart attacks or strokes compared with a generic alternative or Pfizer Inc.’s Lipitor. . . .

“Treatment with the combination Vytorin drug really showed no significant difference in those clinical results when compared with what we tried to match up as equipotent doses of simvastatin and [Lipitor] alone,” said Brian Solow, senior medical director at Prescription Solutions. . . .

* * * *

[AND FROM THE BLOOMBERG VERSION]

* * * *

. . . .The analysis suggests that heart patients may fare just as well by taking the least-expensive cholesterol-lowering pill. Simvastatin costs 84 cents for a 40 milligram dose, compared with $3.91 for the same dosage of Lipitor and $3.74 for Vytorin. A study last year showed that Vytorin worked no better than simvastatin at reopening arteries and a separate study reported this week found that Abbott Laboratories’ Niaspan may be superior to Vytorin in certain patients. . . .

“This looks at a real world context of 30,000 total lives and we are looking at the lives they would normally lead while on these medications,” said Brad Curtis, a vice president and medical director for Prescription Solutions. “We are showing how it looks out there in the real world. . . .”

The evidence continues to pile up, here.